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Low‐dose amphotericin b lipid complex vs. conventional amphotericin B for empirical antifungal therapy of neutropenic fever in patients with hematologic malignancies – a randomized, controlled trial
Author(s) -
Subirà Maricel,
Martino Rodrigo,
Gómez Lucia,
Martí Josep María,
Estany Cristina,
Sierra Jorge
Publication year - 2004
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2004.00239.x
Subject(s) - medicine , amphotericin b , nephrotoxicity , toxicity , chemotherapy , randomized controlled trial , adverse effect , incidence (geometry) , mycosis , amphotericin b deoxycholate , cumulative incidence , gastroenterology , neutropenia , transplantation , surgery , antifungal , caspofungin , dermatology , physics , optics
Background: Conventional amphotericin B (c‐AmB) remains the empirical antifungal treatment of choice for neutropenic patients with persistent fever of unknown origin (FUO). Unfortunately, empirical treatment with c‐AmB is hampered by its safety profile, with frequent infusion‐related adverse events (IRAEs) and renal toxicity. Amphotericin B lipid complex (ABLC) has been investigated for this indication due to its low toxicity profile. The recommended dose of ABLC is 5 mg/kg/d, which is five to seven times higher than the recommended dose of c‐AmB. Methods: This randomized, controlled trial includes 105 adult patients with hematologic malignancies and with FUO after receiving chemotherapy or autologous stem cell transplantation. Patients were randomly allocated to receive ABLC at 1 mg/kg/d or c‐AmB at 0.6 mg/kg/d for empirical antifungal therapy. Results: The incidence of renal toxicity was significantly lower in the ABLC group, compared with c‐AmB group: 8% vs. 32%, respectively ( P = 0.003). The rates of IRAEs were similar in both groups (73% for ABLC vs. 77% for c‐AmB). The overall response rate was 72% for ABLC compared with 48% for c‐AmB ( P = 0.018). This difference was mainly due to the significantly higher renal toxicity in the c‐AmB group. The number of emergent fungal infections and overall mortality were similar in both groups. Conclusions: This randomized trial suggests that ABLC at 1 mg/kg/d produces less nephrotoxicity than c‐AmB, without differences in the incidence of IRAEs and with similar efficacy.